Every Part D plan has a list of covered drugs called a formulary.  Medicare provides insurance companies that sell Part D plans guidelines for the classes of drugs they have to cover but does not always specify the exact drugs that must be included on the formulary. Medicare excludes some drugs from their list of drugs that must be covered. However, Part D plans can include them by using an enhanced formulary, which is an expanded list of covered drugs. In addition to the drugs covered, the Part D formulary includes information on deductibles, copays, and coinsurance that are applied to each drug. There are other rules about how the drugs are provided and approved defined in the Part D formulary. The most important and common are step therapy, prior authorization, and quantity limits, which are described below:

Step Therapy – This process you to start with the most cost-effective drug and only move to other, more costly, or risky medications if the others do not work.

Prior Authorization – Prior authorization requires Part D members to have their physician get approval from the insurance company prior to a prescription being written for a patient.

Quantity Limits – For bot